Studies show that handwashing with soap can reduce the risk of contracting diarrhoea by up to 47%. In Fort Dauphin, a small town in the South East of Madagascar, poor hygiene practices and widespread open defecation has had serious consequences for a population struggling with diarrhoea and malnutrition. Poverty and poor infrastructure means that the overwhelming majority of residents do not have in-house water connections. Water must bought by the bucket, at public water points throughout the town. With water such a scarce resource, handwashing is not always seen as a primary concern.

Approaches addressing widespread open defecation practices in southeast Madagascar must navigate strongly held cultural values, traditions and taboos. In the urban commune of Fort Dauphin, this has resulted in SEED Madagascar’s adoption of a ‘hybrid’ approach to CLTS through Project Malio, a three-year urban sanitation project which seeks to instigate behaviour change by increasing access to improved sanitation in households and schools.